NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

Doing business as Stoneybrook Physicians

  • Federally Qualified Health Center (FQHC)
  • Newport News, VA
National Provider Identifier
1174656862
Registry record updated Sep 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
Stoneybrook Physicians
Practice address
15425H Warwick Blvd
Newport News, VA 23608
Phone
(757) 874-8400
Fax
(757) 874-2295
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Futrell
Title
Chief Executive Officer
Phone
(757) 591-0643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

15425H Warwick Blvd
Newport News, VA 23608

Mailing address

1033 28TH St
2ND Floor
Newport News, VA 23607-4233
Phone (757) 591-0643

Other identifiers 1

IdentifierTypeStateIssuer
007687648MedicaidVA

Other names 1

  • Stoneybrook Physicians Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040611000280 VA Part B Supplier - Clinic/Group Practice 9234040148 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chesapeake, VA; Virginia Beach, VA; Suffolk, VA; Newport News, VA; Hampton, VA
O20101014001149 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Newport News, VA

Federally qualified health center certification: CCN 491856

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
STONEYBROOK PHYSICIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 21, 2003
Last certification
Nov 21, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 1978 in VA
Enrollment address
15425 Warwick Blvd
Ste H
Newport News, VA 23608-1579

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Peninsla Inst-Com HLT I8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15425 Warwick Blvd
Newport News, VA 23608
Phone (757) 874-8400

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Katherine Grant-Davis Individual Corporate DirectorMember Jun 25, 2015
Dorothy Murray Individual Corporate DirectorVice Chair Mar 31, 2009
Shirley Wills Individual Corporate DirectorParliamentarian Apr 26, 2012
Asa Jenrette Individual Corporate DirectorMember Jun 25, 2015
Angela Futrell Individual Corporate DirectorCeo May 5, 2008
W-2 Managing EmployeeCeo May 1, 2008
Robert Ayers Individual Corporate DirectorSecretary Feb 29, 2000
Denise Counce Individual Corporate DirectorMember Mar 25, 2013
Wanda Allen Individual Corporate DirectorChair Jul 29, 1997
Aravia Johnson Individual Corporate DirectorMember Jun 25, 2015
Barbara Easter Individual Corporate DirectorMember May 31, 2012
Eugene Walden Johnson Individual Corporate DirectorParliamentarian Jul 26, 1990

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stoneybrook PhysiciansNewport News, VA, CCN 491913 Federally qualified health center Operational/Managerial Control Aug 16, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1174656862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 28TH ST",
            "address_2": "2ND FLOOR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074233",
            "telephone_number": "757-591-0643",
            "fax_number": "757-591-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15425H WARWICK BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "23608",
            "telephone_number": "757-874-8400",
            "fax_number": "757-874-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-591-0643"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007687648",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stoneybrook Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.